Biomedical subjects

R J Rydman

Publications and source records attributed to R J Rydman.

39 records · Page 3Linked to original sources

PubMedDate not supplied

Paramedic diagnostic accuracy for patients complaining of chest pain or shortness of breath.

INTRODUCTION: A multitude of life-threatening and nonlife-threatening processes cause chest pain and shortness of breath. Prehospital therapy for these patients may be lifesaving and includes pharmacologic interventions, as well as invasive procedures. Appropriate therapy depends on the diagnostic skills of the paramedic. OBJECTIVE: This study was undertaken to determine the accuracy of the paramedic diagnosis in patients transported with a chief complaint of pain or shortness of breath. SETTING: Multihospital, one large municipal hospital, one community hospital. DESIGN: Prospective, cross-sectional study. Paramedics evaluated the patient and then completed a standard form indicating the diagnosis. The paramedic's and final emergency physician's diagnoses were compared to assess the accuracy of the paramedic diagnosis. POPULATION: All patients who complained of chest pain or shortness of breath, transported to the study centers by the city of Denver paramedics, were eligible for the study. Ninety-nine of the 102 patients enrolled had complete records for analysis and were entered into the study. RESULTS: Diagnostic concordance data were analyzed by organ system (e.g., cardiac, pulmonary, etc.) and for specific diagnoses using the kappa statistic and McNemar's chi-square analysis for discordant pairs. Using the kappa statistic, there was statistically significant concordance between the paramedic and emergency-physician diagnosis for cardiac (p = 0.0001; kappa value = 0.54) and pulmonary organ systems (p = 0.0001; kappa value = 0.61). Overall, for organ system diagnosis, the paramedics had an 82% accuracy (p = 0.05) rating. For specific cardiac and pulmonary diagnosis, paramedics had good concordance with emergency physicians. CONCLUSIONS: Overall, paramedics have excellent diagnostic agreement with emergency-physician diagnosis by organ system. They retained good agreement on specific cardiac diagnoses and pulmonary diagnosis.

Adolescent↗

PubMedDate not supplied

An evaluation of research training in a large residency program.

OBJECTIVE: Evaluation of a research training program for emergency medicine residents. METHODS: A cross-sectional, descriptive analysis of knowledge and skill acquisition observed following the introduction of a resident research curriculum was performed at a university-affiliated emergency medicine residency program within a large-volume, inner-city hospital. The didactic program was based upon a published SAEM model research curriculum and included tutorials in computer applications for research. Seventeen first-year residents participated in the new curriculum and self-assessment evaluation. The rate of research proposal preparation after curriculum implementation for the 17 course participants was compared with that of 26 historical control subjects from the same residency program. RESULTS: Resident attendance for the sessions, offered twice annually, averaged 82%. Significant self-perceived knowledge gains (p < 0.05) were found in the areas of study design and methods, journal selection, research planning, and two microcomputer application areas. There was a strong correlation between postcourse examination scores for many specific subject areas and attendance at the related sessions. Thirteen of the 17 participants (76%) completed an original (NIH PHS398-formatted) research proposal within four months following the training program, compared with only six of 26 residents (23%) not exposed to such a curriculum in previous years (p < 0.05). CONCLUSION: Residents appeared satisfied with this level of training and made gains in their skills and knowledge of research activities. The rate of preparation of research proposals by course attendees surpassed that of former residents. This educational intervention may augment the standard practice of faculty mentorship of residents and fellows for research knowledge and skill acquisition.

Curriculum↗

PubMedDate not supplied

Rural community hospitals and factors correlated with their risk of closing.

The issue of rural hospital closings in the United States in recent years has become of increasing concern to health care policy analysts. Rural communities face unique health needs, necessitating access to local health care. Much has been written about the social, economic, legislative, and technological changes that have increased the stress on rural hospitals in the 1980s. However, quantifiable models have been lacking with which to examine in detail factors associated with rural hospitals and to correlate such factors with individual hospitals' risks of closing. In this study, we identify variables correlated with rural community hospital closures in the period 1980-87. Using epidemiologic case-control methods, 161 closed rural hospitals were matched 1 to 3 with a control group of 483 rural hospitals which remained open during the same period. A series of hospital performance indicators and demographic, economic, and social community variables were entered into a multiple logistic regression model. Four variables were found to be positively correlated with risk of closure. They are for-profit ownership; nongovernment, not-for-profit ownership; presence of a skilled nursing or other longterm care unit; and the number of other hospitals in the county. Variables negatively correlated with risk of closure were accreditation by the Joint Commission on the Accreditation of Healthcare Organizations, the number of facilities and services, and membership in a multihospital system. Policy and research implications at the Federal, State, and local levels are discussed.

Accreditation↗